A difficult aspect of many surgical procedures is obtaining and maintaining clear and unobstructed visibility at the surgical site. Accordingly, the instruments and fixtures used in a surgical setting are meticulously designed and selected to ensure that the surgeons have optimum visual access to the surgical site. In most instances, irrigation and suction are used in one form or another to wash away and remove unwanted or undesirable material, fluids, or other particulates. In prolonged surgical procedures, irrigation is also useful in preventing the deleterious effects of tissue desiccation.
Visibility requirements are particularly acute when the surgery involves particularly delicate or small structures, such as those routinely encountered in vascular or neurological surgery. In a vascular anastomosis procedure, for example, even small amounts of fluid or other material can significantly affect the surgeon's view of the anastomotic site. Blood flow from the surrounding tissues or from the vessels themselves is particularly problematic for visualization of the surgical site during an anastomosis. In such procedures, standard liquid irrigation alone is often ineffective for clearing the surgical site.
Instruments using a directed gas or fluid stream to obtain a clear view of the surgical site are known. For example, U.S. Pat. No. 5,336,170 to Salerno et al. discloses a surgical site visualization wand which has a fluid delivery conduit having a fan shaped tip for delivering a pressurized gas to a target site. The visualization wand may also have a humidification or moisturizing conduit for the selective introduction of a sterile liquid in the form of a mist carried by and intermixed with the gas stream to the target site. Such arrangements tend to have the improved ability to blow away fluid or debris without desiccating tissue. U.S. Pat. No. 5,336,170 is hereby incorporated herein in its entirety, by reference thereto. Directed stream visualization instruments such as those described in U.S. Pat. No. 5,336,170 are cumbersome to operate, offering inadequate gas and liquid flow control. If the flow rate of the gas supply is too low, it will not adequately clear the targeted site of undesired material. If the gas stream is delivered at an excessive flow rate or pressure it tends to cause a certain amount of spattering of the cleared material and may displace or damage the delicate tissue structures under operation. If the flow rate of the liquid is too high it may over-irrigate the site; too low and the surrounding tissue may become desiccated.
The directed stream blower disclosed in U.S. Pat. No. 6,168,577 provides a flow controller directly on the handle of the instrument for convenient one-handed operation during use. U.S. Pat. No. 6,168,577 is hereby incorporated herein in its entirety, by reference thereto. The directed stream blower instrument of U.S. Pat. No. 6,168,577 however, like the instrument disclosed in U.S. Pat. No. 6,168,577, is a stand alone instrument that must be individually handheld, independent of other instruments that may be required for the surgical procedure. Typically, a directed stream instrument of this type is held by a surgical assistant, who must then frequently communicate with the surgeon to coordinate position of a blower mister stream, as needed, in the locations needed, at the times needed, and at the flow rates/pressures needed. Additionally, the extra space taken up by the person holding the directed stream instrument and/or the additional space required by the separate instrument itself may be deleterious, especially in instances where the surgical working space is already very limited.
U.S. Pat. No. 6,994,669 discloses a blower that is removably attachable to another surgical instrument at a distal end portion thereof. However, it appears that a proximal end portion of the blower still needs to be held by an operator, which would thereby require an occupation of an additional hand, whether that of the surgeon or a surgeon's assistant. Additionally, the direction of the blower stream does not appear to be adjustable.
U.S. Pat. No. 7,056,287 discloses a blower mounted on a distal end portion of another surgical instrument wherein the blower is adjustable via a malleable tube that includes the lumen through which pressurized gas is delivered. However, this blower is not removable from the additional surgical instrument. Also, bending of the malleable tube can cause kinking, which can adversely affect the flow characteristics of the pressurized gas through the malleable tube.
In view of the foregoing, it would be desirable to provide a blower mister instrument that is more versatile than those of the prior art, that can be used as a standalone instrument, or alternatively can be combined with another instrument, and which may even be used in still further additional operating configurations. It would further be desirable to provide a blower mister instrument that has the capability of changing and controlling a direction in which pressurized fluids are emitted from a distal tip of the instrument, wherein lumens through which the fluids are delivered are formed by conduits that do not readily kink and are not malleable. Still further it would be desirable to provide a blower mister instrument wherein a length from the distal tip to the handle of the instrument is adjustable.